Physician Focus: Eating disorders on the rise

As many as 10 million females and 1 million males in the U.S. are affected by eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder.

Dr. Esther Dechant and Beth Mayer

As many as 10 million females and 1 million males in the U.S. are affected by eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder. These conditions are often hard to detect, carry great shame, and present severe physical and mental health problems for patients. Many of those afflicted are young adolescents, teenagers and young adults.

The vast majority of patients with anorexia and bulimia some 85-95 percent are women. Binge eating disorder affects about 2 percent of all adults up to 4 million Americans, affecting slightly more women than men. Recent studies have discovered an increasing incidence of these disorders among males. The peak onset of these conditions occurs during late puberty and in the late teenage and early adult years.

Anorexia nervosa is characterized by a refusal to maintain a normal body weight through self-induced starvation. Bulimia nervosa consists of episodes of binge eating consuming large amounts of food in a short amount of time in a way that feels out of control followed by actions to compensate for overeating, such as vomiting, restricting food or the use of laxatives. Those suffering from anorexia and bulimia have common traits: they fear gaining weight, are fixated on losing weight, and are very dissatisfied with their bodies. Binge eating disorder consists of consuming large amounts of food but without the compensatory actions to purge one's system; it's often associated with obesity.

Medicine has yet to pinpoint the specific causes of these illnesses, but we do know that certain factors contribute to them. Among them are cultural issues, such as the pressure to be thin or fit a certain body size or image, and stressful psychological situations, such as traumatic events in childhood, troubled personal relationships, or major changes in life. Family influence also plays a role; those with a relative with a disorder or those whose parents constantly criticize their appearance are more susceptible. Research is also pointing to biology and genetics as additional causes. Health professionals agree, however, that it is usually not one trigger that leads to an eating disorder, but rather a combination of factors.

The mental and physical health issues usually occur in tandem. Low self-esteem, depression and anxiety are among the mental health issues patients face. And the consequences to one's physical health are serious.

The most serious physical effects of anorexia, for example, include cardiac conditions from a weakened heart, which in severe cases can result in sudden death. Another danger is deteriorating bone health, a particular concern for adolescents because the teenage years are the most important for developing strong bones. If a strong skeleton and bone structure do not develop during those years, a lifelong, debilitating, and potentially irreversible condition can result.

The danger from bulimia comes from the purging of what has been consumed, which changes electrolyte levels in the body and can also cause cardiac problems. Gastrointestinal issues may also arise from the constant purging. The effects of binge eating are similar to those of obesity heart conditions, diabetes, high blood pressure and high cholesterol.

Treating these ailments can be complex. In most cases, they are usually treated on an outpatient basis, although hospitalization may be required. While health providers treat the eating disorder, they also address all of the other issues that accompany it, such as depression, anxiety, body image and self-esteem. These disorders consume great amounts of time, change the way a person lives, take up a lot of what we call "psychological space," and seriously disrupt lives. But there is hope.

The first step to recovery is getting the right treatment. Psychotherapy is a beneficial tool for individuals struggling with eating disorders, and can allow the person to understand the root causes of the eating disorder and how to cope with and manage their feelings. Nutritional therapy is also critical to the recovery process and teaches the patient to practice healthy, mindful eating with the support of a trained professional. While these disorders can be difficult and affect the whole family as well as the individual patient, treatment does work and patients do get better. For more information on eating disorders, visit the Multi-service Eating Disorders Association at medainc.org or the National Eating Disorders Association at edap.org. For a video discussion, go to www.physicianfocus.org.

Esther Dechant, M.D., is medical director of the Klarman Eating Disorders Center at McLean Hospital in Belmont, Mass., and Beth Mayer, LICSW, is chief executive officer of the Multi-Service Eating Disorders Association based in Newton, Mass. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.